Abstract
Background
The treatment approach to node-positive gallbladder cancer has unresolved issues with
regard to the management of patients with a positive superior retro-pancreatic (level
13a) node, which is the highest level of spread. The American Joint Committee on Cancer
remains unclear on the status of the 13a node.
Methods
This retrospective study consisted of 165 patients with node-positive gallbladder
cancer without distant metastasis. Patients were reclassified according to the American
Joint Committee on Cancer eighth edition classification. The survival of patients
with positive level 13a node was compared with that of patients with N1 disease (T
stage-wise) and those with para-aortic nodal disease. A multivariate analysis was
performed for factors affecting survival.
Results
The 5-year survival of patients with positive level 13a with 1–3 nodes was similar
to those with N1 disease (40.2% and 32.9%, respectively) and was better than those
with more distant nodal spread (P < .05). In univariate and multivariate analyses, intraoperative blood loss (hazard
ratio [HR] 1.58), R1 resection (HR 1.87), and T4 disease (versus T2, HR 3.44) were
poor prognosticators. Pancreaticoduodenectomy may be beneficial in T2 patients.
Conclusion
A positive superior retro-pancreatic node does not worsen the prognosis in an otherwise
N1 disease in T1/T2 gallbladder cancer. It behaves like a regional lymph node and
should be treated as such.
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Biography
Article info
Publication history
Published online: October 19, 2018
Accepted:
September 14,
2018
Received in revised form:
September 14,
2018
Received:
May 19,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
